Managed Care Contract & Consulting Services
○ Contracts in place
○ Managed Care system in place
○ Facility – effective communication for teamwork
○ Health plans have a job to do
○ Health plan needs
○ Educate staff
○ Prepare/train team
○ Understand philosophy change
○ Market, market, market
○ Communication with vendors, doctors, those servicing SNF
1. Resistance to change of philosophy and pace
2. Decentralized case management – Things fall through the cracks that almost always result in revenue loss
3. What the health plan wants
4. The health plan has a job to do
5. Cash Flow & Reimbursement
6. A contract can only be great if it is used to its maximum potential
○ Medicare – All eggs in ONE basket
○ Contracts ?
○ Lacks current information
○ Complexities of managing ○ Skilled/Custodial stay of HMO beneficiary
○ What change means?
○ Billing: long-term and short-term
○ Length of stay
○ Initial Evaluations
○ Facility Team
4. Does your staff know how often to communicate with the health plans and when to inform the plan that patients' level of care has changed?
5. Does your facility check eligibility and benefits upon admission and on a weekly basis? This is a MUST DO in many states where managed care initiatives have begun.
6. Are you getting full revenue reimbursement on all contracts?
7. Do you have a specialist to answer your managed care questions?
Business Office Managers
If you answered “No” to any of the above questions, Mix Solutions can help!
With managed care shrinking our profits, mastering managed care is IMPERATIVE.
MANAGED CARE STATUS CHECK: